U.S. patent application number 16/369528 was filed with the patent office on 2019-07-25 for apparatus and method for intra-cardiac mapping and ablation.
The applicant listed for this patent is Kardium Inc.. Invention is credited to Daniel GELBART, Samuel Victor LICHTENSTEIN.
Application Number | 20190223950 16/369528 |
Document ID | / |
Family ID | 48780484 |
Filed Date | 2019-07-25 |
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United States Patent
Application |
20190223950 |
Kind Code |
A1 |
GELBART; Daniel ; et
al. |
July 25, 2019 |
APPARATUS AND METHOD FOR INTRA-CARDIAC MAPPING AND ABLATION
Abstract
An intra-cardiac mapping system is based on locating the ports
through which blood flows in or out the heart chambers. For many
procedures, such as ablation to cure atrial fibrillation, locating
the pulmonary veins and the mitral valve accurately allows to
perform a Maze procedure. The location of the ports and valves is
based on using the convective cooling effect of the blood flow. The
mapping can be performed by a catheter-deployed expandable net or a
scanning catheter. The same net or catheter can also perform the
ablation procedure.
Inventors: |
GELBART; Daniel; (Vancouver,
CA) ; LICHTENSTEIN; Samuel Victor; (Vancouver,
CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Kardium Inc. |
Burnaby |
|
CA |
|
|
Family ID: |
48780484 |
Appl. No.: |
16/369528 |
Filed: |
March 29, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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15697744 |
Sep 7, 2017 |
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16369528 |
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14804810 |
Jul 21, 2015 |
9987083 |
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15697744 |
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13785931 |
Mar 5, 2013 |
9119633 |
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14804810 |
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11475950 |
Jun 28, 2006 |
8920411 |
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13785931 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 2018/0237 20130101;
A61B 18/082 20130101; A61B 2018/00357 20130101; A61B 18/20
20130101; A61B 34/25 20160201; A61B 5/6858 20130101; A61B
2018/00642 20130101; A61B 5/028 20130101; A61B 5/02055 20130101;
A61B 5/027 20130101; A61B 34/10 20160201; A61B 18/18 20130101; A61B
2018/00351 20130101; A61B 2018/00714 20130101; A61B 18/02 20130101;
A61B 2018/00577 20130101; A61B 18/10 20130101; A61B 5/6853
20130101; A61B 5/743 20130101; A61B 90/37 20160201; A61B 2018/0016
20130101; A61B 2034/101 20160201; A61B 2018/0022 20130101; A61B
2018/00875 20130101; A61B 2018/00791 20130101; A61B 2018/0212
20130101; A61B 2018/00267 20130101; A61B 2018/124 20130101; A61B
2562/046 20130101; A61B 5/015 20130101; A61B 18/1492 20130101; A61B
2018/1407 20130101 |
International
Class: |
A61B 18/14 20060101
A61B018/14; A61B 18/08 20060101 A61B018/08; A61B 5/028 20060101
A61B005/028; A61B 18/10 20060101 A61B018/10; A61B 5/00 20060101
A61B005/00; A61B 34/00 20060101 A61B034/00; A61B 34/10 20060101
A61B034/10; A61B 90/00 20060101 A61B090/00; A61B 5/027 20060101
A61B005/027; A61B 5/0205 20060101 A61B005/0205; A61B 5/01 20060101
A61B005/01 |
Claims
1. (canceled)
2. An ablation-pattern display system comprising: a control
computer; and at least one display console connected to the control
computer, the control computer configured to: cause the at least
one display console to display a visual representation indicating
each ablation element in a first ablation element set in an
overlapping relationship with an opening in an intra-cardiac
cavity, the visual representation indicating each ablation element
in a second ablation element set in an overlapping relationship
with tissue surrounding at least part of the opening in the
intra-cardiac cavity, at least part of the visual representation
derived at least in part from information provided to the control
computer from a sensing element set positionable in the
intra-cardiac cavity, and the ablation elements in the first and
the second ablation element sets providing a plurality of ablation
elements arrangeable in a spatial distribution in a state in which
the plurality of ablation elements is deployed in the intra-cardiac
cavity, each ablation element of the plurality of ablation elements
selectively operable to cause tissue ablation; receive user-input
indicating user-selected ablation elements of at least some of the
ablation elements in the second ablation element set to define a
user-selected tissue ablation pattern; and cause, prior to
beginning ablation of the user-selected tissue ablation pattern,
the at least one display console to display the visual
representation as including a graphical representation of the
user-selected tissue ablation pattern at least in response to the
user-input, the graphical representation visually indicating a
plurality of first graphical elements, the plurality of first
graphical elements respectively corresponding to the user-selected
ablation elements, wherein the visual representation comprises a
plurality of second graphical elements, at least some of the
plurality of first graphical elements surrounding at least some of
the plurality of second graphical elements, the plurality of second
graphical elements respectively corresponding to non-user-selected
ablation elements, the plurality of second graphical elements
depicted differently within the visual representation than the
plurality of first graphical elements, and the plurality of first
graphical elements and the plurality of second graphical elements
collectively spatially arranged in the visual representation in
correspondence with the spatial distribution.
3. The ablation-pattern display system of claim 2, wherein the
visual representation visually indicates the plurality of first
graphical elements and the plurality of second graphical elements
in an arrangement comprising a plurality of rows and a plurality of
columns, wherein each row of (a) at least two of the rows, each
column of (b) at least two of the columns, or each row and column
of both (a) and (b) respectively comprises graphical depictions of
at least one graphical element of the plurality of first graphical
elements and at least one graphical element of the plurality of
second graphical elements.
4. The ablation-pattern display system of claim 2, wherein the
visual representation visually indicates the plurality of first
graphical elements and the plurality of second graphical elements
in an arrangement comprising a plurality of rows and a plurality of
columns, wherein each row of (a) at least two of the rows, each
column of (b) at least two of the columns, or each row and column
of both (a) and (b) respectively comprises graphical depictions of
at least two graphical elements of the plurality of first graphical
elements.
5. The ablation-pattern display system of claim 2, wherein the
graphical representation of the user-selected tissue ablation
pattern represents the user-selected tissue ablation pattern as
comprising elongated segments along different ones of multiple
axes.
6. The ablation-pattern display system of claim 5, wherein the
plurality of first graphical elements are the elongated
segments.
7. The ablation-pattern display system of claim 2, wherein the
control computer is further configured to cause the at least one
display console to display a grid comprising a plurality of rows
and a plurality of columns, wherein the graphical representation of
the user-selected tissue ablation pattern occurs in alignment with
the rows and columns of the grid.
8. The ablation-pattern display system of claim 2, wherein each
graphical element of the plurality of first graphical elements and
each graphical element of the plurality of second graphical
elements is an elongated segment.
9. The ablation-pattern display system of claim 2, wherein the
plurality of ablation elements is formed as a mesh.
10. The ablation-pattern display system of claim 2, wherein the
plurality of ablation elements is configured to assume different
positions including a position suitable for percutaneous delivery
to the intra-cardiac cavity and an expanded position in which the
plurality of ablation elements is deployed in the intra-cardiac
cavity.
11. The ablation-pattern display system of claim 2, wherein the
plurality of first graphical elements, which respectively
correspond to the user-selected ablation elements, are emphasized
as compared to the plurality of second graphical elements, which
respectively correspond to the non-user-selected ablation
elements.
12. The ablation-pattern display system of claim 2, wherein each
ablation element of the plurality of ablation elements is
configured to ablate tissue using RF ablation, laser ablation,
microwave ablation, or cryogenic ablation.
13. The ablation-pattern display system of claim 2, wherein each
sensing element in the sensing element set is configured to sense
blood flow.
14. The ablation-pattern display system of claim 13, wherein the
control computer is configured to cause each ablation element of at
least some ablation elements of the plurality of ablation elements
to be switchable between (a) a mapping mode in which the ablation
element is operable to provide sensed blood flow information, and
(b) an ablation mode in which the ablation element is operable to
ablate tissue.
15. The ablation-pattern display system of claim 2, wherein each
sensing element in the sensing element set is configured to sense
temperature.
16. The ablation-pattern display system of claim 2, wherein the
sensing element set comprises a plurality of sensing elements
arranged in an array.
17. The ablation-pattern display system of claim 2, wherein the
sensing element set is configured to indicate a positioning of a
portion of a catheter in the intra-cardiac cavity, the catheter
comprising at least the plurality of ablation elements.
18. The ablation-pattern display system of claim 17, wherein the
catheter comprises the sensing element set.
19. The ablation-pattern display system of claim 2, wherein the
sensing element set is configured to indicate a positioning of each
ablation element in the second ablation element set in the
overlapping relationship with the tissue surrounding the at least
part of the opening in the intra-cardiac cavity.
20. The ablation-pattern display system of claim 19, wherein the
sensing element set is configured to indicate a positioning of each
ablation element in the first ablation element set in the
overlapping relationship with the opening in the intra-cardiac
cavity.
21. The ablation-pattern display system of claim 20, wherein a
catheter comprises the plurality of ablation elements and the
sensing element set.
22. The ablation-pattern display system of claim 2, wherein the
plurality of ablation elements is connected to the control
computer, and wherein the control computer is configured to operate
the user-selected ablation elements of the plurality of ablation
elements to cause ablation of the user-selected tissue ablation
pattern in tissue of the intra-cardiac cavity.
23. An ablation-pattern display method executed by a control
computer, the method comprising: causing at least one display
console connected to the control computer to display a visual
representation indicating each ablation element in a first ablation
element set in an overlapping relationship with an opening in an
intra-cardiac cavity, the visual representation indicating each
ablation element in a second ablation element set in an overlapping
relationship with tissue surrounding at least part of the opening
in the intra-cardiac cavity, at least part of the visual
representation derived at least in part from information provided
to the control computer from a sensing element set positionable in
the intra-cardiac cavity, and the ablation elements in the first
and the second ablation element sets providing a plurality of
ablation elements arrangeable in a spatial distribution in a state
in which the plurality of ablation elements is deployed in the
intra-cardiac cavity, each ablation element of the plurality of
ablation elements selectively operable to cause tissue ablation;
receiving user-input indicating user-selected ablation elements of
at least some of the ablation elements in the second ablation
element set to define a user-selected tissue ablation pattern; and
causing, prior to beginning ablation of the user-selected tissue
ablation pattern, the at least one display console to display the
visual representation as including a graphical representation of
the user-selected tissue ablation pattern at least in response to
the user-input, the graphical representation visually indicating a
plurality of first graphical elements, the plurality of first
graphical elements respectively corresponding to the user-selected
ablation elements, wherein the visual representation comprises a
plurality of second graphical elements, at least some of the
plurality of first graphical elements surrounding at least some of
the plurality of second graphical elements, the plurality of second
graphical elements respectively corresponding to non-user-selected
ablation elements, the plurality of second graphical elements
depicted differently within the visual representation than the
plurality of first graphical elements, and the plurality of first
graphical elements and the plurality of second graphical elements
collectively spatially arranged in the visual representation in
correspondence with the spatial distribution.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of prior U.S. patent
application Ser. No. 15/697,744, filed Sep. 7, 2017, which is a
continuation of prior U.S. patent application Ser. No. 14/804,810,
filed Jul. 21, 2015, now U.S. Pat. No. 9,987,083 issued on Jun. 5,
2018, which is a continuation of prior U.S. patent application Ser.
No. 13/785,931, filed Mar. 5, 2013, now U.S. Pat. No. 9,119,633,
issued on Sep. 1, 2015, which is a continuation-in-part of prior
U.S. patent application Ser. No. 11/475,950, filed Jun. 28, 2006,
now U.S. Pat. No. 8,920,411, issued on Dec. 30, 2014, the entire
disclosure of each of these applications is hereby incorporated
herein by reference.
TECHNICAL FIELD
[0002] This disclosure generally relates to minimally invasive
heart surgery, also known as percutaneous cardiac surgery and
particularly relates to percutaneous mapping and ablation.
BACKGROUND
[0003] Atrial fibrillation is a well known disorder in which
spurious electrical signals cause an irregular heart beat. The
disorder has a well known cure known as the Maze procedure, in
which a border is ablated around the sources of the spurious
signals, typically in the left atrium but sometimes in the right
atrium. The procedure is very commonly performed under direct
vision, but difficult to perform percutaneously via a catheter
because of the associated risk. Any error in navigation inside the
heart can cause fatal damage. The key to a percutaneous procedure
is mapping of the inside of the right and left atrium. Access to
the right atrium is simple via the superior vena cava; the left
atrium can be reached i) by perforating the transatrial septum, ii)
via the aorta and the left ventricle or iii) via the pulmonary
veins.
[0004] Prior approaches to map the inside of the atrium relied on
electrical activity picked up from the atrium wall. These
approaches require intimate electrical contact, not always possible
because of scar tissue and deposits. These approaches may fail to
accurately map the edges of the openings where the veins enter the
atrium; information that is useful for correct placement of the
ablation pattern. Other mapping methods, such as using an array of
ultrasonic transducers, are not practical since such arrays
typically will not fit through a catheter of a reasonable size
(8-10 mm diameter). A superior mapping apparatus and method, that
enables safe execution of the Maze and other intra-cardiac
procedures is desirable.
[0005] A good survey article on the subject is: "Ablation of Atrial
Fibrillation: Energy Sources and Navigation Tools: A survey" by
Ruediger Becker and Wolfgang Schoels (J. of Electrocardiology, Vol
37, 2004, pp 55-61). The article includes an extensive
bibliography.
SUMMARY
[0006] Embodiments of an intra-cardiac mapping system are based on
locating openings or ports and values through which blood flows in
or out of the heart chambers. For many procedures, such as ablation
to cure atrial fibrillation, accurately locating the pulmonary
veins and the mitral valve allows performance of a Maze procedure.
The openings, ports and valves may be located based on the
convective cooling effect of the blood flow. The mapping can be
performed by a catheter-deployed expandable net or a scanning
catheter. The same net or catheter can also perform the ablation
procedure.
[0007] In one embodiment, a method for intra-cardiac mapping
comprises: introducing a plurality of flow sensors into an
intra-cardiac cavity: locating points in a wall forming said cavity
based on sensing blood flow; and mapping said walls of said cavity
based on said points. The method for intra-cardiac mapping may
include said blood flow being sensed by its convective cooling
effect on a heated sensor. The method for intra-cardiac mapping may
include said sensing being done by a steerable linear array. The
method for intra-cardiac mapping may include said mapping being
used for treating atrial fibrillation by RF ablation. The method
for intra-cardiac mapping may include being used for treating
atrial fibrillation by microwave ablation. The method for
intra-cardiac mapping may include said mapping being used for
treating atrial fibrillation by cryogenic ablation. The method for
intra-cardiac mapping may include said mapping being used for
treating atrial fibrillation by laser ablation. The method for
intra-cardiac mapping may include said blood flow being sensed by
the resistance change of a heated resistive wire.
[0008] In another embodiment, a method for intra-cardiac mapping
comprises: introducing an expandable sensing mesh into said cavity
via a catheter; using said mesh to locate openings in walls forming
said cavity based on the convective heat transfer of blood flowing
through said holes; and mapping inside of said cavity based on
location of said openings. The method for intra-cardiac mapping may
include said blood flow being sensed by its convective cooling
effect on a heated sensor. The method for intra-cardiac mapping may
include said sensing being done by a steerable linear array. The
method for intra-cardiac mapping may include said mapping being
used for treating atrial fibrillation by RF ablation. The method
for intra-cardiac mapping may include said mapping being used for
treating atrial fibrillation by microwave ablation. The method for
intra-cardiac mapping may include said mapping being used for
treating atrial fibrillation by cryogenic ablation. The method for
intra-cardiac mapping may include said mapping being used for
treating atrial fibrillation by laser ablation. The method for
intra-cardiac mapping may include said blood flow being sensed by
the resistance change of a heated resistive wire. The method for
intra-cardiac mapping may include said mesh comprising small coils
of nickel wire wound on a mesh of a flexible insulator. The method
for intra-cardiac mapping may include an electronic switch used to
minimize the number of electrical wires passing through said
catheter.
[0009] In yet another embodiment, a method for treating atrial
fibrillation comprises: introducing at least one flow sensor into
an intra-cardiac cavity; locating points in a wall forming said
cavity based on sensing blood flow; mapping walls of said cavity
based on said points; and ablating a pattern into walls of said
cavity based on said mapping. The method for treating atrial
fibrillation may include said blood flow being sensed by its
convective cooling effect on a heated sensor. The method for
treating atrial fibrillation may include said sensing being done by
a steerable linear array. The method for treating atrial
fibrillation may include said mapping being used for treating
atrial fibrillation by RF ablation. The method for treating atrial
fibrillation may include said mapping being used for treating
atrial fibrillation by microwave ablation. The method for treating
atrial fibrillation may include said mapping being used for
treating atrial fibrillation by cryogenic ablation. The method for
treating atrial fibrillation may include said mapping being used
for treating atrial fibrillation by laser ablation. The method for
treating atrial fibrillation may include said blood flow being
sensed by the resistance change of a heated resistive wire. The
method for treating atrial fibrillation may include said flow
sensors also acting as electrodes for said ablation. The method for
treating atrial fibrillation may include said flow sensor being
based on temperature sensing and a same sensor being used to
monitor temperature during said ablation. The method for treating
atrial fibrillation may include said ablation being unipolar. The
method for treating atrial fibrillation may include said ablation
being bipolar. The method for treating atrial fibrillation may
include said ablated pattern being a Maze procedure.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] In the drawings, identical reference numbers identify
similar elements or acts. It is to be understood that the attached
drawings are for purposes of illustrating the concepts of the
invention and may not be to scale. For example, the sizes, relative
positions, shapes, and angles of or associated with elements in the
drawings are not necessarily drawn to scale, and some elements may
be arbitrarily enlarged and positioned to improve drawing
legibility. Further, the particular shapes of the elements as drawn
may differ from their actual shapes and, in this regard, may be
selected instead of the respective actual shapes for ease of
recognition in the drawings.
[0011] FIG. 1 is a cross sectional view of the heart showing the
mapping mesh deployed in the left atrium.
[0012] FIG. 2 is a cross sectional view of the sensing device.
[0013] FIGS. 3A and 3B are isometric views of the mesh in both
folded and expanded position.
[0014] FIG. 4 is an isometric enlarged view of a portion of the
mesh.
[0015] FIG. 5 is an electrical schematic of a mapping and ablation
system.
[0016] FIG. 6 is an electrical schematic of a simplified mapping
system.
[0017] FIG. 7 is a schematic view of the display console of the
system.
[0018] FIGS. 8A and 8B are graphical views of a mapping that
illustrate an interpolation principle.
[0019] FIG. 9 is a cross sectional view of an alternate embodiment,
using mechanical or manual scanning in one axis.
[0020] FIG. 10 is a cross sectional view of an alternate
embodiment, using mechanical scanning in two dimensions.
[0021] FIG. 11 shows the use of the invention for bipolar
ablation.
DETAILED DESCRIPTION
[0022] In the following description, certain specific details are
set forth in order to provide a thorough understanding of various
disclosed embodiments. However, one skilled in the relevant art
will recognize that embodiments may be practiced without one or
more of these specific details, or with other methods, components,
materials, etc. In other instances, well-known structures
associated with apparatuses and methods for intra-cardiac mapping
and ablation have not been shown or described in detail to avoid
unnecessarily obscuring descriptions of the embodiments.
[0023] Unless the context requires otherwise, throughout the
specification and claims which follow, the word "comprise" and
variations thereof, such as, "comprises" and "comprising" are to be
construed in an open, inclusive sense, that is as "including, but
not limited to."
[0024] Reference throughout this specification to "one embodiment"
or "an embodiment" means that a particular feature, structure or
characteristic described in connection with the embodiment is
included in at least one embodiment. Thus, the appearances of the
phrases "in one embodiment" or "in an embodiment" in various places
throughout this specification are not necessarily all referring to
the same embodiment. Furthermore, the particular features,
structures, or characteristics may be combined in any suitable
manner in one or more embodiments.
[0025] As used in this specification and the appended claims, the
singular forms "a," "an," and "the" include plural referents unless
the content clearly dictates otherwise. It should also be noted
that the term "or" is generally employed in its non-exclusive sense
including "and/or" unless the content clearly dictates
otherwise.
[0026] The headings and Abstract of the Disclosure provided herein
are for convenience only and do not interpret the scope or meaning
of the embodiments.
[0027] FIG. 1 shows a sensing and ablation mesh 7 inserted into a
left atrium 3 of a heart 1 according to one illustrated
embodiment.
[0028] By way of example, the mesh 7 may be delivered via a
catheter 60 inserted via a superior vena cava 4 and penetrating a
transatrial septum from a right atrium 2 of the heart 1. The mesh 7
is communicatively coupled to the rest of the system, for example,
by electrical wires 6.
[0029] Before any ablation takes place, the inside of the left
atrium 3 is mapped in order to locate the openings or ports 8
leading to the pulmonary veins 5, as well as the mitral valve 9. A
typical Maze procedure ablates a "fence" around openings or ports 8
to stop propagation of spurious electrical signals which cause the
heart 1 to contract at the wrong times.
[0030] The mapping may locate some or all of the openings or ports
8 through which blood flows in and out of the left atrium 3, as the
Maze procedure is mainly concerned with the location of these
openings or ports 8. By the way of example, in the left atrium 3,
the four openings or ports 8 leading to the pulmonary veins 5 as
well as the mitral valve 9 may be located. The location of these
openings or ports 8 may be based on the fact that the convective
cooling effect of the blood is significant, and a slightly heated
mesh 7 pressed against the walls of the left and/or right atrium 3,
2 will be cooler at the areas which are spanning the openings or
ports 8 carrying blood.
[0031] FIG. 2 shows the ablation mesh 7 covered by miniature
heating and/or temperature sensing elements 10a-10c flow
(collectively 10, only three illustrated in the figure). Each one
of these elements 10a-10c comprises a few turns of a resistive
wire, for example nickel wire, wound on an electrically insulated
mesh. A low current is passed through each element 10, raising a
temperature of the element 10 by about 1 degree C. above normal
blood temperature. A first element 10b, which lies across an
opening or port 8 of one of the pulmonary veins 5, will be cooled
by blood flow. The other elements are against a wall 3 and hence do
not lie across any of the openings or ports 8.
[0032] By identifying the relatively cooler elements 10a, 10c on
the mesh 7, the location of the openings or ports 8 may be
found.
[0033] This method does not require intimate contact with the wall
3, as the cooling effect is significant even a few millimeters away
from the opening.
[0034] The same elements 10 can be used as ablation electrodes
during an ablation stage. It was found that the power required to
raise the temperature of the mesh 7 by a small but easily
detectable amount is very small, on the order of 10-50 mW per
element 10. If the elements 10 are made of a material that has a
significant change in resistance with temperature, the temperature
drop can be sensed by measuring a voltage across the element 10
when driven by a constant current. A good choice for element
material is nickel wire, which is inert, highly resistive and has a
significant temperature coefficient of resistance (about 0.6% per
deg C.). Since the resistance of the elements 10 is low (typically
0.1-1 ohm), the electrical noise is very low and temperature
changes as low as 0.1 deg can be easily detected. For even higher
detection sensitivity, the voltage waveform can be sampled in
sychronization with the heart rate or the average voltage removed
and only the change amplified. Such methods are referred to as "AC
coupling". A further refinement to reduce the electrical noise is
to pass the signal through a digital band pass filter having a
center frequency tracking the heart rate. To avoid any potential
tissue damage, the temperature of the elements 10 of the mesh 7 is
only slightly above the blood temperature, typically 0.1-3 degrees
C. above blood temperature.
[0035] FIG. 3A shows the mesh 7 in a compressed configuration "A"
and FIG. 3B shows the mesh 7 in an expanded configuration "B".
Since the mesh 7 has to fit into a catheter 60, the mesh 7 should
be very flexible. Besides elements 10 discussed earlier, there is
also a large number of leads 13 coming out of the mesh 7. Leads 13
can be loose, as shown in FIG. 3B, or may be bonded to the mesh 7.
To avoid feeding a large number of wires all the way to an
operating console, an electronic selector switch may be employed,
which may, for example, be mounted in the catheter 60. This reduces
the number of electrical wires from over 100 to about 10. The mesh
7 can be self-expanding (elastic) or balloon-expandable. Self
expanding allows normal blood flow during the procedure. For
balloon expandable devices, the expansion balloon should be removed
before the mapping, to avoid blocking the flow of blood.
[0036] FIG. 4 shows the mesh 7 in more detail. Insulated
longitudinal (i.e., parallel to catheter) wires 25 are crossed by
cross wires 26. Each section of the mesh 7 is covered by a few
turns of thin (0.05-0.2 mm) nickel wire 10 having leads 13. The
leads 13 can be regular thin copper wire. The longitudinal wires 25
can be stiffer than the cross wires 26, therefore can be made
self-expanding by incorporating a core 14 made of coiled flexible
metal wire such as Nitinol. A metallic core may interfere with the
ablation process at higher frequencies and can be replaced by
simply making the longitudinal wires 25 of a polymeric material
thicker than the cross wires 26. The cross wires 26, which may form
rings around wires 25, should be very flexible to compress into the
catheter 60. The cross wires 26 could incorporate a very thin wire
or coiled up wire. Use of a flexible mesh 7 not only allows
percutaneous delivery, but also permits the mesh 7 to follow the
atrial volume change each heartbeat. The mesh 7 should stay in
contact with or close to the atrial wall during the cardiac cycle,
otherwise the measurement and the ablation may only be performed
during parts of the cardiac cycle. The diameter of the longitudinal
wires 25 and cross wires 26 are typically 0.2-1 mm. The mesh 7 may
include about 10-20 longitudinal wires 25 and about 10-20 cross
wires 26. The insulation can be any polymeric material such as thin
enamel or polymer coating. Practically any polymer can be used, as
the maximum temperature it will be subject to, including during the
ablation phase, is around 100 degrees C.
[0037] FIG. 5 shows an electrical system, according to one
illustrated embodiment. The elements 10 may be resistive heaters
wound on the mesh 7. Each of the elements 10 is connected by
electronic element switches 15 (typically FET or MOS-FET type) to a
single pair of wires leading out of the body to a mode selection
switch 17. Element switches 15 are selected by de-multiplexer or
selector 16. The de-multiplexer or selector 16 is controlled by a
small number of wires or even a single wire if data is sent in
serial form, by a multiplexer 22. Element switches 15 and
de-multiplexer or selector 16 may be built into the catheter 60,
which may, for example, be located near the point of deployment of
the mesh 7. The element switches 15 have to carry significant power
during the ablation phase.
[0038] The mode selection 17 selects between a mapping mode
(position shown in the drawing) and an ablation mode (second
position of switch). In the mapping mode, a current is created by a
voltage source 18 and resistor 19 (e.g., forming a constant current
source) and routed into a selected element 10 by the element
switches 15. For each measurement, the two element switches 15 that
are connected to the scanned element 10 are in an enabled state
(ON), the rest of the element switches being in a disabled state
(OFF). The voltage drop across an element 10 is measured by an
analog to digital (A/D) converter 20 and fed to a control computer
23. For greater accuracy, four terminal sensing can be employed. In
a preferred embodiment, the detection is AC coupled, therefore the
DC voltage drops along the wires are of no consequence, and no
four-terminal sensing is needed. For AC coupling, the control
computer 23 may include a 0.5 Hz low pass filter, which may be
implemented in software. The slight disadvantage of the AC coupled
method approach is speed, as the low signal frequency (e.g., about
1 Hz), requires a few seconds per measurement. Other temperature
sensors and/or approaches, such as thermistors or thermocouples,
can be used in conjunction with the elements 10. Mapping is
achieved by turning on all of the elements 10 (e.g., sequentially)
and measuring the temperature of each. A map may be formed in the
control computer 23 and the lower temperature spots on the mesh
correspond to the openings or ports 8 leading to the veins or
valves.
[0039] When the mode selection switch 17 is in the ablation mode, a
generator 21 (e.g., Radio Frequency (RF)) is connected (e.g.,
sequentially) to selected elements 10 by the control computer 23
addressing the multiplexer 22 which controls the element switches
15 via the de-multiplex selector 16. The complete operation,
including scanning and ablation, can be completed in less than 5
minutes. The configuration illustrated in FIG. 5 implies unipolar
ablation; however bipolar ablation can be used as well and is
discussed below. Clearly other sources of ablation can be used
besides RF. Frequencies from DC to microwaves can be used, as well
as delivery of laser power via optical fibers or cryogenics via
thin tubes. For laser ablation element switches 15 are optical
switches, while for cryogenic ablation the element switches 15 are
valves, and in some embodiments may take the form of heated
elements such as resistive wires.
[0040] During ablation it is desirable to monitor the temperature
of the mode selection switch 17 to the mapping position several
times during the ablation procedure. The measured temperatures can
be displayed on a display 32 (FIG. 7). RF ablation is typically
performed at frequencies of 100 KHz-1 MHz and power levels which
depend on the size of the elements 10, but can be as high as 100 W.
Various RF ablation techniques and equipment are well known in the
art.
[0041] FIG. 6 shows an embodiment in which the mapping system is
separate from the ablation system. In this system, the mesh 7 has
very few connecting wires. As illustrated, each longitudinal wire
25 has a single output wire and each cross wire 26 has a single
output wire 13. For a 10.times.10 mesh 7 with 100 nodes, only
twenty-one wires are needed (ten plus ten plus ground wire),
instead of two hundred wires. This allows all wires to be brought
directly out of the catheter 60. This also allows placement of
selector switches 16 and 24 together with the control system. For
example, if the element marked as "A" is selected; a current is
selected to run through the longitudinal wire 25 which includes
element A. The voltage drop is sensed by the two circumferential
wires 13 that connect directly to A. Since no current flows in the
other elements at the time of measurement, the voltage drop is only
caused by element A. It is sensed by A/D converter 20 via double
pole selector 24.
[0042] After a map is established, it is displayed on a display
screen 32 as shown in FIG. 7. The surgeon can select which elements
10 will cause tissue ablation in the atrium. The pattern formed is
along the line of the standard Maze procedure. The location of the
pulmonary veins 5 and the mitral valve 9 is inferred from the
temperature date and drawn on the display screen.
[0043] FIGS. 8A and 8B demonstrate the principle of accurate
location of the veins and valves even if the grid is relatively
coarse. The exact location can be interpolated based on the fact
that when only part of the element 10 is exposed to the blood flow.
By the way of example, if the temperature of the mesh 7 is 1 degree
C. above blood temperature and equals the blood temperature under
normal blood flow (this was experimentally verified), the
temperatures of a group of elements 10 will be as shown in FIG. 8A
when aligned with the opening or port 8 of vein 5. The number near
each element 10 is the temperature drop. When moved, some of the
elements 10 will only be partially positioned in the flow path
under vein 5, as shown by FIG. 8B. The temperatures of those
elements 10 will be between 0 and 1 degree above blood temperature.
The exact temperature drop between 0 to 1 corresponds with the
exact shift. This allows accurate determination of the location and
size of each opening or port 8, data used by the control computer
23 to draw the map shown in FIG. 7. A grid spacing of 10 mm allows
about 1 mm accuracy.
[0044] An alternative to a full mesh is a partial mesh, or even a
single sensor, that is mechanically scanned across the area to be
mapped. FIG. 9 shows a linear sensor array 27 pushed into the
atrium 2 via vein 4 by the catheter 60. The linear sensor array 27
has a linear array of elements 10 similar to those used in the full
mesh 7. After a linear mapping is performed the linear sensor array
27 is rotated (as shown by broken line 27') a small amount (10-20
degrees) by stem 11 (similar to electrical wires 6) and a new scan
is performed. The same procedures previously described may be used
for ablation.
[0045] FIG. 10 shows the use of a single steerable catheter 28 as a
mapping and ablation tool. Steerable catheters are controlled
remotely by mechanical, magnetic, hydraulic or other means. A
steerable catheter 28 can be used to scan the inside of the atrium
3 by bending, as shown in broken line 28'. The location is
monitored by external or internal sensors. A position of a tip of
the steerable catheter 28 can also be monitored by fluoroscopy. The
catheter tip contains a heating and/or ablation element 10.
Steerable catheters 28 may advantageously carry a wide range of
ablation systems, since only one connection and one point is
needed.
[0046] A full mesh trades a higher complexity for better speed and
accuracy when compared to linear arrays or single point
scanning.
[0047] The previous examples were of unipolar ablation, with the
ablation current returning to ground via the patient's body. The
disclosed system can also be used for bipolar ablation as shown in
FIG. 11. In unipolar ablation the same voltage is connected to both
leads 13 and 13' of an element 10. In bipolar abalation the voltage
is connected to lead 13 while the other end, 13', is grounded. It
is important that the element 10 will be of sufficient resistance
to cause most of the ablation current to flow through heart tissue
1. Electrodes 30 make contact with tissue 1 while the wire used in
the element 10 is covered by an insulator. The advantage of bipolar
ablation is better control of ablation depth. Typical ablation
temperatures are 60-80 degrees C. At a higher temperature the
tissue 1 becomes less conductive, forcing the ablation current to
seek a new path. This promotes full ablation of the tissue 1. The
element 10 can also be designed to assist ablation by creating heat
when ablation voltage is applied across it.
[0048] One possible advantage of at least some of the presently
disclosed embodiments over electrical potential mapping methods is
that the presently disclosed embodiments do not require perfect
contact between the mesh 7 and the tissue 1. The presently
disclosed embodiments may also advantageously be less sensitive to
the surface properties of the tissue, such as scar tissue or
plaque.
[0049] If the mesh is separated from the tissue by a thin layer of
blood, both the temperature sensing and the ablation functions of
the presently disclosed embodiments will still function
properly.
[0050] The word "element" in this disclosure has to be interpreted
in a broad sense as any element capable of sensing blood flow.
Clearly the elements do not need to be heaters, as cooling elements
will work equally well. If a material is injected into the blood
flow, any sensor capable of detecting this material can be used to
detect blood flow. By the way of example, if the blood is cooled or
warmed slightly before returning to the heart only temperatures
sensors are needed. Since temperature differences as low as 0.1
degree C. can be detected reliably, it is fairly simple to heat or
cool the blood slightly before it returns to the heart (even by a
simple external pad).
[0051] The above description of illustrated embodiments, including
what is described in the Abstract, is not intended to be exhaustive
or to limit the embodiments to the precise forms disclosed.
Although specific embodiments of and examples are described herein
for illustrative purposes, various equivalent modifications can be
made without departing from the spirit and scope of the disclosure,
as will be recognized by those skilled in the relevant art.
[0052] The various embodiments described above can be combined to
provide further embodiments. All of the U.S. patents. U.S. patent
application publications, U.S. patent applications, foreign
patents, foreign patent applications and non-patent publications
referred to in this specification and/or listed in the Application
Data Sheet are incorporated herein by reference, in their entirety.
Aspects of the embodiments can be modified, if necessary, to employ
systems, circuits and concepts of the various patents, applications
and publications to provide yet further embodiments.
[0053] These and other changes can be made to the embodiments in
light of the above-detailed description. In general. in the
following claims, the terms used should not be construed to limit
the claims to the specific embodiments disclosed in the
specification and the claims, but should be construed to include
all possible embodiments along with the full scope of equivalents
to which such claims are entitled. Accordingly, the claims are not
limited by the disclosure.
* * * * *